Trikafta and Psychopathology in Cystic Fibrosis: A Case Report
Abstract
Abstract Introduction Patients with cystic fibrosis (CF) have a high prevalence of comorbid anxiety and depressive symptoms, ranging from 8-29% in children and adolescents and 13-33% among adults. There is also a correlation between their physical symptoms and quality of life. A fixed-dose triple combination tablet of the cystic fibrosis transmembrane conductance regulator (CFTR) correctors elexacaftor and tezacaftor, along with the CFTR potentiator ivacaftor (hereafter referred to as TrikaftaTM) has been developed to treat patients with at least one F5508del mutation. No psychiatric or sleep-related adverse events have been reported with this combination until now. Case Report Here we present a case of a female patient who experienced worsening depression, anxiety, and worsening sleep paralysis with hypnopompic hallucinations following initiation of Trikafta therapy for CF, and consequent improvement of psychiatric symptoms following discontinuation and decreased dosing. Discussion In a previous case series, worsening of anxiety and depressive symptoms has been reported with lumacaftor/ivacaftor. Extrapolating from animal studies investigating ivacaftor’s effects on serotonin receptors, we would expect potential improvement of anxiety and depressive symptoms with Trikafta. However, this was not the case and ivacaftor’s effects on 5-HT2A receptors and/or her worsening depression could have played a role in exacerbating our patient’s sleep paralysis. As our patient’s…
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